Official Title

Evaluation of a Tailored Smoking Cessation Treatment Algorithm Based on Initial Treatment Response and Genotype
  • Phase

    Phase 3
  • Study Type

    Interventional
  • Intervention/Treatment

    nicotine bupropion varenicline ...
  • Study Participants

    606
Nicotine replacement therapy (NRT) is a well-tolerated and efficacious smoking cessation treatment, and yet many smokers fail to quit using NRT. Many of these smokers may benefit from prescription treatment alternatives, including Zyban or Chantix. In this study, the investigators propose to develop and evaluate a stepped-care treatment algorithm that would evaluate whether smokers who receive treatment with NRT should be supplemented with Zyban or switched to Chantix only based on: 1) their initial response to NRT; and 2) individual genetic factors found to predict smoking cessation in other studies evaluating these treatments. This study is a continuation of our previous studies showing that abstinence rates can be increased by starting nicotine patch therapy two weeks before the quit date. The investigators will provide pre-cessation NRT to all participants initially. Those who do not show a favorable response on early indicators of success (e.g., smoking in the first week after the target quit-smoking date) will receive "rescue" treatment by having their NRT treatment supplemented with Zyban , by being switched to treatment with Chantix or will remain on NRT (control).

The investigators hypothesize that "Rescue" treatment with Zyban in combination with NRT or Chantix will increase success rates over leaving subjects on NRT when they are NRT insufficient responders, i.e. they have shown an unfavorable response to NRT in the first week pre-quit or the first week post-quit.
Study Started
May 31
2009
Primary Completion
Jul 31
2011
Study Completion
Oct 31
2011
Results Posted
Dec 26
2012
Estimate
Last Update
Sep 23
2013
Estimate

Drug Nicotine Patches

21mg (1 patch) or 42mg (2 patches)nicotine patches for first five weeks (# of daily patches based on baseline carbon monoxide level); 21mg nicotine patch for 4 weeks; 14mg nicotine patch for 2 weeks and 7mg nicotine patch for 2 weeks.

  • Other names: NicoDermCQ

Drug Nicotine patches, then bupropion & nicotine patches (Pre-Quit)

21mg (1 patch) or 42mg (2 patches) nicotine patches for first week (# of daily patches based on baseline carbon monoxide level); starting with week 2: 150mg of bupropion once daily and 21mg (1 patch) or 42mg (2 patches)nicotine patches for first 3 days (# of daily patches based on baseline carbon monoxide level); 150mg of bupropion twice daily and 21mg (1 patch) or 42mg (2 patches)nicotine patches for 3 weeks and 4 days (# of daily patches based on baseline carbon monoxide level); 150mg of bupropion twice daily and 21mg nicotine patch for 4 weeks; 150mg of bupropion twice daily and 14mg nicotine patch for 2 weeks and 150mg of bupropion twice daily and 7mg nicotine patch for 2 weeks.

  • Other names: NicoDermCQ, Zyban

Drug Nicotine patches, then varenicline (Pre-Quit)

21mg (1 patch) or 42mg (2 patches) nicotine patches for first week (# of daily patches based on baseline carbon monoxide level); starting with week 2: 0.5mg of varenicline once daily for first 3 days; 0.5mg of varenicline twice daily for the next 4 days; and 1mg of varenicline twice daily for the remainder of the study (11 weeks)

  • Other names: Chantix, NicoDermCQ

Drug Nicotine patches, then nicotine patches (Pre-Quit)

21mg (1 patch) or 42mg (2 patches)nicotine patches for first five weeks (# of daily patches based on baseline carbon monoxide level); 21mg nicotine patch for 4 weeks; 14mg nicotine patch for 2 weeks and 7mg nicotine patch for 2 weeks.

  • Other names: NicoDermCQ

Drug Nicotine patches, then bupropion & nicotine patches (Post-Quit)

21mg (1 patch) or 42mg (2 patches) nicotine patches for first three weeks (# of daily patches based on baseline carbon monoxide level); starting with week 4: 150mg of bupropion once daily and 21mg (1 patch) or 42mg (2 patches) nicotine patches for first 3 days (# of daily patches based on baseline carbon monoxide level); 150mg of bupropion twice daily and 21mg (1 patch) or 42mg (2 patches) nicotine patches for 3 weeks and 4 days (# of daily patches based on baseline carbon monoxide level); 150mg of bupropion twice daily and 21mg nicotine patch for 4 weeks; 150mg of bupropion twice daily and 14mg nicotine patch for 2 weeks and 150mg of bupropion twice daily and 7mg nicotine patch for 2 weeks.

  • Other names: Zyban, NicoDermCQ

Drug Nicotine patches, then varenicline (Post-Quit)

21mg (1 patch) or 42mg (2 patches) nicotine patches for first three weeks (# of daily patches based on baseline carbon monoxide level); starting with week 4: 0.5mg of varenicline once daily for first 3 days; 0.5mg of varenicline twice daily for the next 4 days; and 1mg of varenicline twice daily for the remainder of the study (11 weeks)

  • Other names: Chantix, NicoDermCQ

Drug Nicotine patches, then nicotine patches (Post-Quit)

21mg (1 patch) or 42mg (2 patches) nicotine patches for first seven weeks (# of daily patches based on baseline carbon monoxide level); 21mg nicotine patch for 4 weeks; 14mg nicotine patch for 2 weeks and 7mg nicotine patch for 2 weeks.

  • Other names: NicoDermCQ

Nicotine Replacement Therapy Responder Active Comparator

Nicotine Responders

Pre-Quit Rescue to Bupropion & Nicotine Active Comparator

Participants not responsive to nicotine patches who are randomly assigned at week 2 to use of Zyban (bupropion) in combination with nicotine patches

Pre-Quit Rescue to Varenicline Active Comparator

Participants not responsive to nicotine patches who are randomly assigned at week 2 to use of Chantix (varenicline)

Pre-Quit Rescue to Nicotine Active Comparator

Participants not responsive to nicotine patches who are randomly assigned at week 2 to continued use of nicotine patches

Post-Quit Rescue to Bupropion & Nicotine Active Comparator

Participants not responsive to nicotine patches who are randomly assigned at week 4 to use of Zyban (bupropion) in combination with nicotine patches

Post-Quit Rescue to Varenicline Active Comparator

Participants not responsive to nicotine patches who are randomly assigned at week 4 to use of Chantix (varenicline)

Post-Quit Rescue to Nicotine Active Comparator

Participants not responsive to nicotine patches who are randomly assigned at week 4 to continued use of nicotine patches

Criteria

Inclusion Criteria:

18-65 years old
smoked an average of at least 10 cigarettes per day for three cumulative years of a brand that delivers (by Federal Trade Commission rated yields) at least 0.5mg nicotine
expired carbon monoxide reading of at least 15ppm
express a desire to quit smoking in the next 30 days

Exclusion Criteria:

Hypertension (systolic >140 mm Hg, diastolic >100 mm Hg, coupled with a history of hypertension); subjects with no previous diagnosis of hypertension may have a screening blood pressure up to 160/100.
Hypotension (systolic <90 mm Hg, diastolic <60 mm Hg).
Participants with a history of hypertension may, however, be allowed to participate in the study if the study physician or physician assistant determines that the condition is stable, controlled by medication, and in no way jeopardizes the individual's safety.
Coronary heart disease;
Lifetime history of heart attack;
Cardiac rhythm disorder (irregular heart rhythm);
Chest pains (unless history, exam, and ECG clearly indicate a non-cardiac source);
Cardiac (heart) disorder (including but not limited to valvular heart disease, heart murmur, heart failure);
History of skin allergy;
Active skin disorder (e.g., psoriasis) within the last five years, except minor skin conditions (including but not limited to facial acne, minor localized infections, and superficial minor wounds);
Liver or kidney disorder (except kidney stones, gallstones);
Gastrointestinal problems or disease other than gastroesophageal reflux or heartburn;
Active ulcers in the past 30 days;
Lung disorder (including but not limited to Chronic obstructive pulmonary disease (COPD), emphysema, and asthma);
Brain abnormality (including but not limited to stroke, brain tumor, and seizure disorder);
History of migraine headaches in the past 5 years;
History of fainting;
Problems giving blood samples;
Diabetes treated with insulin; non-insulin treated diabetes (unless glucose is less than 180mg/dcl and HbA1c is less than 7%);
Current cancer or treatment for cancer in the past six months (except basal or squamous cell skin cancer);
Other major medical condition;
Current psychiatric disease (with the exception of anxiety disorders, Obsessive-compulsive disorder (OCD) and ADHD);
Suicidal ideation (within the past 10 years) or lifetime occurrence of attempted suicide;
Current depression - The Patient Health Questionnaire (PHQ-9) for Depression will be used to screen for current (within 2 weeks) depression. Potential subjects who score >9 (or who score >0 on item #9 ("Thoughts that you would be better off dead, or of hurting yourself in some way") will be excluded from study participation, and, at the discretion of the study physician, referred to appropriate psychiatric treatment;
Bulimia or anorexia;
Pregnant or nursing mothers;
Use (within the past 30 days) of:
Illegal drugs (or if the urine drug screen is positive),
Experimental (investigational) drugs;
Psychiatric medications including antidepressants, anti-psychotics or any other medications that are known to affect smoking cessation (e.g. clonidine);
Opiate medications for pain or sleep (non-opiate medication for pain or sleep will be allowed)
Smokeless tobacco (chewing tobacco, snuff), cigars or pipes;
Wellbutrin, bupropion, Zyban, Chantix, nicotine replacement therapy or any other smoking cessation aid.
Alcohol abuse - The AUDIT (Alcohol Use Disorders Identification Test) questionnaire will be used to assess alcohol abuse. Potential participants will be asked the first two questions on the AUDIT questionnaire during the phone screen. If the person scores "4" on both questions, a screening appointment will not be scheduled. During the screening session the entire AUDIT questionnaire will be administered. Females who score greater than or equal to 13 and males who score greater than or equal to 15 will be excluded from the study.
Significant adverse reaction to Wellbutrin / Zyban or Chantix / Varenicline in the past

Summary

NRT Responder

Pre-Quit Randomization to Bupropion + NRT

Pre-Quit Randomization to Varenicline

Pre-Quit Randomization to NRT

Post-Quit Randomization to Bupropion + NRT

Post-Quit Randomized to Varenicline

Post-Quit Randomized to NRT

All Events

Event Type Organ System Event Term NRT Responder Pre-Quit Randomization to Bupropion + NRT Pre-Quit Randomization to Varenicline Pre-Quit Randomization to NRT Post-Quit Randomization to Bupropion + NRT Post-Quit Randomized to Varenicline Post-Quit Randomized to NRT

Continuous 4-week Abstinence From Smoking Between Weeks 8-11 After the Quit Date (Through the End of Treatment)

A self report of no cigarettes smoked confirmed by expired air carbon monoxide of <=10ppm was the criterion for abstinence.

NRT Responder

59.2
percentage of subjects abstinent
95% Confidence Interval: 50.4 to 68.0

Pre-Quit Randomization to Bupropion + NRT

28.3
percentage of subjects abstinent
95% Confidence Interval: 19.4 to 37.2

Pre-Quit Randomization to Varenicline

23.3
percentage of subjects abstinent
95% Confidence Interval: 15.1 to 31.5

Pre-Quit Randomization to NRT

16.0
percentage of subjects abstinent
95% Confidence Interval: 9.0 to 23.0

Post-Quit Randomization to Bupropion + NRT

26.7
percentage of subjects abstinent
95% Confidence Interval: 10.9 to 42.5

Post-Quit Randomized to Varenicline

37.1
percentage of subjects abstinent
95% Confidence Interval: 21.1 to 53.1

Post-Quit Randomized to NRT

26.7
percentage of subjects abstinent
95% Confidence Interval: 10.9 to 42.5

Abstinence (7 Days) at 6 Months.

NRT Responder

21.7
percentage of subjects

Pre-Quit Randomization to Bupropion + NRT

17.2
percentage of subjects

Pre-Quit Randomization to Varenicline

16.5
percentage of subjects

Pre-Quit Randomization to NRT

6.6
percentage of subjects

Post-Quit Randomization to Bupropion + NRT

10.0
percentage of subjects

Post-Quit Randomized to Varenicline

20.0
percentage of subjects

Post-Quit Randomized to NRT

13.3
percentage of subjects

Continuous Abstinence From Smoking at 6 Months Post Quit.

Pre-Quit Randomization to NRT

5.8
percentage of subjects

Post-Quit Randomization to Bupropion + NRT

10.0
percentage of subjects

Post-Quit Randomized to Varenicline

14.3
percentage of subjects

Post-Quit Randomized to NRT

10.0
percentage of subjects

NRT Responder

20.0
percentage of subjects

Pre-Quit Randomization to Bupropion + NRT

13.1
percentage of subjects

Pre-Quit Randomization to Varenicline

5.8
percentage of subjects

Total

606
Participants

Age Continuous

44.3
years (Mean)
Standard Deviation: 10.8

Age, Categorical

Region of Enrollment

Sex: Female, Male

Overall Study

NRT Responder

Pre-Quit Randomization to Bupropion + NRT

Pre-Quit Randomization to Varenicline

Pre-Quit Randomization to NRT

Post-Quit Randomization to Bupropion + NRT

Post-Quit Randomized to Varenicline

Post-Quit Randomized to NRT

Withdrew Prior to Randomization

Drop/Withdrawal Reasons

NRT Responder

Pre-Quit Randomization to Bupropion + NRT

Pre-Quit Randomization to Varenicline

Pre-Quit Randomization to NRT

Post-Quit Randomization to Bupropion + NRT

Post-Quit Randomized to Varenicline

Post-Quit Randomized to NRT

Withdrew Prior to Randomization